Fine Needle Aspiration Cytology of Metastatic Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is uncommon cutaneous malignant neuroendocrine tumour of the elderly people with rapidly growing skin nodules found frequently on sun-exposed areas of the body. MCC is often an aggressive tumour with high tendency for local recurrence, lymph node involvement and distant metastases. This paper reports a case of metastatic MCC diagnosed by fine needle aspiration cytology (FNAC), flow cytometric deoxiribonucleated acid (DNA) analysis, pathohistology and electron microscopy. The cytological features in aspirate (stained with Papenheim and Papanicolaou staining) included increased cellularity, discohesive groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei with moulding effect, fine chromatin, multiple micronucleoli and scanty cytoplasm. DNA flow cytometric analysis of the aspirate showed unexpected results for clinically aggressive behaviour of this tumour (the patient died after 21 months), and revealed that tumour contained diploid peak with DNA index of 1.1. The proliferation was high with elevated S-phase fraction (21%). The cytological diagnosis of possible metastatic MCC was confirmed by histological one as well as by electron microscopy presented the pathognomonic features for this tumour: dense-core neurosecretory granules with diameter of 100–250 nm surrounded by whorls of intermediate filaments. MCC provides an enormous challenge for the morphologist because of a wide range of differential diagnosis and for the clinician because this tumour has a highly malignant potential for local recurrence, nodal and distant spread and very often is combined with other tumours. Therefore it is important to perform FNAC of different lesions in the same patient because it can distinguish MCC from the other tumours

Life Threatening Complications after Unsuccessful Attempt of the Guidewire Dilating Forceps Tracheostomy in Multi-Trauma Patient with Cervical Spine Injury

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance

Švanom brahijalnog pleksusa – prikaz slučaja i pregled literature

Schwannoma as an extracranial nerve sheath tumor rarely affects brachial plexus. Due to the fact that brachial plexus schwannomas are a rare entity and due to the brachial plexus anatomic complexity, schwannomas in this region present a challenge for surgeons. We present a case of a 49-year-old female patient with a slow growing painless mass in the right supraclavicular region that was diagnosed as schwannoma and operated at our department. The case is described to remind that in case of supraclavicular tumors, differential diagnosis should take brachial plexus tumors, i.e. schwannomas, in consideration. Extra caution is also required on fine needle aspiration procedures or biopsies of schwannomas due to the possible iatrogenic injury of the nerve and adjacent structures. On operative treatment of schwannoma, complete tumor resection should be achieved while preserving the nerve.Švanom kao ekstrakranijski tumor ovojnice živca rijetko zahvaća brahijalni pleksus. S obzirom na činjenicu da su šva-nomi brahijalnog pleksusa rijedak entitet i s obzirom na anatomsku složenost brahijalnog pleksusa švanomi u ovoj regiji predstavljaju izazov za kirurge. U ovom radu predstavljamo slučaj 49-godišnje bolesnice sa sporo rastućom bezbolnom tvorbom desno supraklavikularno, koja je dijagnosticirana kao švanom i operirana na našem Zavodu. Ovaj slučaj prikazu-jemo kako bismo upozorili na to da kod supraklavikularnih tumora treba diferencijalno dijagnostički misliti i na tumore brahijalnog pleksusa, to jest švanome. Također, dodatni oprez je potreban prilikom citoloških punkcija i biopsija švanoma zbog moguće jatrogene ozljede živca i priležećih struktura. Kirurškim liječenjem švanoma potrebno je postići potpunu resekciju tumora uz očuvanje živca

Life threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy in multi-trauma patient with cervical spine injury [Životno ugrožavajuće komplikacije nakon neuspjela pokušaja perkutane traheotomije kod politraumatizitanog bolesnika s ozljedom vratne kralježnice]

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance

Brachial Plexus Schwannoma – Case Report and Literature Review

Schwannoma as an extracranial nerve sheath tumor rarely affects brachial plexus. Due to the fact that brachial plexus schwannomas are a rare entity and due to the brachial plexus anatomic complexity, schwannomas in this region present a challenge for surgeons. We present a case of a 49-year-old female patient with a slow growing painless mass in the right supraclavicular region that was diagnosed as schwannoma and operated at our department. The case is described to remind that in case of supraclavicular tumors, differential diagnosis should take brachial plexus tumors, i.e. schwannomas, in consideration. Extra caution is also required on fine needle aspiration procedures or biopsies of schwannomas due to the possible iatrogenic injury of the nerve and adjacent structures. On operative treatment of schwannoma, complete tumor resection should be achieved while preserving the nerve

Životno ugrožavajuće komplikacije nakon neuspjela pokušaja perkutane traheotomije kod politraumatizitanog bolesnika s ozljedom vratne kralježnice

Percutaneous tracheostomy (PCT) is a safe method under proper patient selection, increased technical experience and bronchoscopy- or ultrasound-guided procedure. Trauma patients with cervical spine fractures and spinal cord injury are at a high risk for respiratory failure and require a definitive airway followed by prolonged mechanical ventilation. We would like to present multiple, life- threatening complications after unsuccessful attempt of the guidewire dilating forceps tracheostomy (GWDF) in one trauma patient with a cervical spine injury. With this case report we would like to lay emphasis on the importance of continuously bronchoscopy- or ultrasound-guided PTC in trauma patients, especially with cervical spine injury, as the need to respect the steep-learning curve in its performance.Perkutana traheotomija (PTC) je klinički široko prihvaćena metoda osiguravanja dišnog puta u jedinicama intenzivne skrbi. Pravilna selekcija bolesnika prema opće prihvaćenim indikacijama i anatomskim markacijama uz kontinuiranu vizualizaciju postupka bronhoskopom (ili ultrazvukom) osigurava sigurno izvo|enje svakog njegovog segmenta. Sveukupni porast tehničkoga iskustva u izvo|enju PCT neminovno doprinosi smanjenju nastanka mogućih neželjenih komplikacija. Bolesnici sa ozljedom vratne kralježnice, sa ili bez pridružene ozljede vratnoga dijela le|ne moždine čine visokorizičnu skupinu bolesnika sa pojavom produžene respiracijske insuficijencije i potrebom za mehaničkom ventilacijom kod kojih je traheotomija u većini slučajeva neizbježna. Ovim opisom kliničkog slučaja želimo prikazati nastale višestuke, po život opasne komplikacije nakon neuspješnoga pokušaja izvo|enja PCT kod politraumatiziranog bolesnika sa pridruženom povredom vratnog dijela kralježnice. Njime tako|er želimo istaći važnost kontinuirane vizualizacije cjelokupnog postupka izvo|enja PTC (bronhoskopom ili ultrazvukom) kao i poštivanja graduacije stjecanja tehničke i praktične vještine osobe kao i tima koje je izvodi